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Friday, April 25, 2008

"Death Outside the Dying Rooms"

There is much debate as to how accurate BBC's 1995 documentary "The Dying Rooms" was. The idea that children were neglected to the point of death is hard for many to accept. But perhaps there is a more common explanation for infant mortality in the orphanages -- not a result of outright neglect so much as a result of ignorance and laziness.

The following story was sent to me by a Western Aid Volunteer working in a large orphanage in northern China. This volunteer has assisted the orphanage for over half a decade, and has seen this issue upfront and personal. Their story offers an interesting insight into this problem, yet an insight that encourages us to support organizations such as "Love Without Boundaries" and "Half-the-Sky" in their work to surgically repair children with cleft pallets, for example, and to educate caregivers in how to provide proper care for special need children. Issues remain, but these and other programs are making a difference.

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The “Dying Rooms” report by BBC over a decade ago made the claim that orphanages in China regularly made conscious decisions to let children die of starvation. There have been many records released of the children’s deaths in various facilities and survival rates published that proved that these orphanages had zero population growth. "Zero population growth" means that the number of children under the authority of the CWI does not increase. In other words, the number of adoptions, deaths and transfers (when the children age out) are equal or greater than the number of incoming children. I know in the orphanage I worked in that the number of children coming in was around 200, sometimes 250 per year. Only recently have the number of adoptions reached 50 (and 2008 might be close to 100). Of course, I do not have numbers for other orphanages, but I assume they are similar. In any event, I do know that adoption was less frequent 1995-1999, and the number of incoming children was about the same. Yet, the population of the orphanage did not increase. As adoptions and "age out" transfers are done according to known standards, this requires a lot of deaths, most of which are preventable.

I do not want to contradict the report; in fact, I do not doubt that it could have happened. However, in my personal experience, zero population growth in Chinese orphanages could have several other reasons that would not be immediately evident to casual observers.

I came to China in 2000, long after the Dying Rooms report and after several orphanages had begun to make major changes. The city I came to is in northern China, and almost 95% of the children at the CWI are special needs. I worked with an organization that provided caretaker salaries, surgeries and supplies, as well as allowed volunteers, both foreign and Chinese, to help with the care of the children.

The two most common special needs that we saw (and still see) were cleft palates and cerebral palsy. The CWI at this time was just beginning to have positive survival rates.

One of the groups of children who would often not do very well were the cleft-affected children. They would often die of malnutrition. Foreign volunteers regularly volunteered here, and if there had been a “dying room”, we would have been able to find evidence. However, the caretakers, through a lack of training and proper equipment, were unable to get enough nourishment down the children. There were several reasons for this.

The first is that a cleft palate affects a child’s sucking power. Caretakers used to feeding NSN kids would place a bottle in their mouth and then wonder why they were not drinking. After a few minutes, they would claim the child was not hungry and give up.

The caretakers were not maliciously harming the child, but their lack of training, overwhelming number of children to feed, and, at times, laziness affected the children. I do not believe this to be a “dying room” situation, in that no one picked out children to die and never touched them again. However, these were very preventable deaths.

The first solution our organization had to this problem was to get the children into foster care with foreign families. Over a period of around 10 years, a large number of expatriate families in this city fostered and eventually adopted cleft-affected children from the CWI. However, this method was labor-intensive and could not reach all of the children in need.

Our next solution was for training. We negotiated with the director, leadership, and caretakers to teach them about how to feed the children properly. This meant that the caretakers had to put more effort into their jobs. This was not accepted by all very easily, but they eventually came around.

We also provided equipment -- specifically cleft-palate nipples that provided for one-way flow and eliminated the need to suck. These nipples (at least the brand we bought) could not be obtained in China.

Another major problem that led to the preventable deaths of several of the children was poor positioning while feeding. Almost all children who could not sit up by themselves were fed lying flat on their backs. Even for a healthy person, this makes swallowing difficult. For children with cerebral palsy, whose muscle control and swallowing reflexes are poor, it is dangerous. Often, the children would aspirate food, develop lung infections or pneumonia and eventually die.

In contrast to issues with cleft palates, I believe this issue to be much more the fault of the system and individual caretakers and supervisors than just ignorance and bad luck. Sitting a child up for feeding is not terribly difficult or counter-intuitive. However, I do not believe that back feeding was done in order to harm the children, but simply because the caretakers were too lazy and/or unconcerned.

However, what makes these issues relevant to the community of those involved with China’s Welfare Institutions is that both of these situations existed long after the light of foreign media had some to China’s orphanages, and was only changed with the direct supervision of foreign personnel. For orphanages where the majority of children are handicapped, laziness and ignorance could easily account for zero population growth much more easily than outright euthanasia.

I am certain that these conditions exist in other orphanages in China. The path of improvement does not lie with freshly painted walls, children who know how to put on a lovely performance, or even tons of foreign money. All of these things are good, but to truly change the lives of the children, we will need to change the hearts of minds of the caretakers. teachers and supervisors who care for them.

Thanks for this article Brian.I think the time is long past due that we begin to get some real answers about what is happening inside of China's orphanages.I understand that non-profit organizations need to walk a careful path to continue to gain access to kids who need care, what really drives me crazy is that China has the means now to care for their own children and yet they still find others who will do it.I hope the future will bring more clarity to this program and more truth for the children.They deserve truth, if nothing else.

You cant make people care when they just don't. I suggest that financial incentives be offered to the caretakers for healthy children and low mortality rates. A prize given to the team or group with the healthiest children and the least deaths or hospitalizations. They use such incentives for doctors in England to push preventative care.

There are a few very disturbing videos on youtube showing these dying rooms. I assumed that they were old footage - but they do raise some issues about the level of care in some of the orphanages. Our daughter was technically malnourished when we picked her up 9 months ago. She weiged 15 pounds at 16 months old ( 29 inches). And we were told that she came from a good orphanage. It's hard to imagine that a sick child could thrive or survive in these conditions - when even the "healthy" kids are getting minimal nourishment.

this is a very good thing you are doing. chinese orhanages always try to cover up their wrong doings to the world so that they wont go out of buisness. your doing a good thing letting the world know what they are doing. oh and keep informing us we really appreciate it!:)

if it is ignorance than why do they save the male children and not the female? i understand that the babies you spoke of were handicapped, but overall they are extremely cruel to the female babies from what i saw on the videos.. was letting that 2 year old girl starve to death in a dark room ignorance or cruelty?

i dont know who the chinese government are to say that you can only have one child .did u know that this is the result of it. and yes there is "dying rooms" in chana as it shows you on the documentory . the reason why it is all girls in the orphanidges is because chinease cultural people think that the boys can carry on the family name ...They also think taht girls cost too much because they will not work.. what they dont realise is that if it carries on like this then there will be a major shortage of girls . andd that will be the end of china !!!!

I'm from Russia. If journalists had been in Russia they'd have seen the same. Children are unnecessary here. Orphanages and internats are awful places for murder of kids as boys as girls. Indifference of a society is the reason of a children's death.

There are 600.000 orphans in China and thise is the result when you give these children to underpayd selfish uneducated people who do not care about the children. This is happening right now in China. There are places where kids are looked after but thre are also similar places that is showed in thise document. One thing has changed that reporters and cameras are not allowed in these facilities. Foreigners are not allowed to enter orphanages at all. People who adob from China can only go to very few places so you do not see the bad places in the countryside. If you try you are arrested. I have work with human rights in China and if you are caught you will never get a visa or you are jailed or put to house arrest so if you do not hear something it probably means the voice is silenced. Not that the problems are gone. Last week BBC reporters were silenced and stopped filming in Beijing because they were filming in a place where "Jasmin" peaceful demonstration was going to happen. To prevent thise happening goverment also blocked word Jasmin from google in China.

I worked for the largest US International Adoption agency in the late 90s.

The disturbing thing to me, at the time, was that 99% of the homestudies that passed my desk required "healthy newborns." It was disturbing because I was regularly updated with photographs/information about hundreds of children who languished in orphanages with precisely the "special needs" you cite.

I'd heard about the dying rooms and assumed it was possible. I assumed, if children did end up in such a horrific place, they were those chidren who were not wanted by potential US adopters -- children who suffered with cleft palates, Mercury poisoning issues, or clubbed foots. Children who, by and large, were considered "unadoptable" based on US "clients'" specifications.

I'd felt good about my work, initially. I'd felt we were rescuing orphans. I later heard accounts of women bringing their girls to a specific bus station, where they knew American adoption workers would be ... and they wept upon handing them over.

But I couldn't continue to feel good about what we facilitated because, much like it is here in the US, it was all about "healthy newborns."

Worse, the "parenting plan" (I'd say about 80% of the time) deferred the infants to full-time daycare after just six weeks.

Six weeks! These were typically high-income families with money in reserve. Yet they were opting to take an already abandoned child into their home for only six weeks before shipping him or her out for 9 hours a day, with yet another stranger.

I could not, in good conscience, endorse this.

I don't know what the solution is. Children who need to be adopted, who need to be saved, aren't because they're not newborns... much like it is here in the US.

The documentary video is evidence enough that they are inhuman starving that 2 year old to death ahes skin and bones already i dont even see tgat ahe us cleft pallate. They are just child abusers and insensitive treating the babies like nothing at all. They dont care. So evil

I dont believe that the caretakera are just untrained. They even tie the feet of toddlers together in bamboo chairs. The babies cannot walk around, they are tied like dogs. They are worst than child abusers. A slow painful death of starvation. I saw the 2 year old girl in one of tge dying room video she has no name. Shes not even cleft palate but yet died of neglect and starvation. Her body us skin and bones. They are not just lazy and untrained. They are inhuman and evil!!!!!!!